Embed Size (px)
Citation preview
National Center for Health Statistics
Mortality Data Release:Maternal Mortality Highlight
Amy Branum, Ph.D.
January 30, 2020
National Center for Health Statistics (NCHS): What We Do
▪ Monitor the nation’s health by collecting, analyzing, and disseminating health data to:
o Compare across time, populations, providers, & geographic areas
o Identify health problems, risk factors, & disease patterns
o Inform actions & policies to improve the health of the American people
o Administer cross-cutting, comprehensive, & foundational data collections that address the full range of public health issues including emerging concerns
▪ As the designated Federal statistical agency for health, NCHS provides data that are unavailable elsewhere for informed decision-making
Data Systems
National
Health
Interview
Survey
National
Health and
Nutrition
Examination
Survey
National Vital
Statistics
System
National
Health Care
Surveys
National Vital Statistics System (NVSS) and the Vital Statistics Cooperative Program (VSCP)
▪ States register all births and deaths
▪ NCHS receives vital records from jurisdictions on birth, death, and fetal death
▪ Federal-State contractual arrangement– 50 States, New York City, District of Columbia and 5 US territories
– Federal government provides funding, coordination, and standards
– States maintain autonomy in their operations, but collect and provide data according to standard specifications and agreed upon timelines
Maternal Mortality
Maternal Mortality Data at NCHS
▪NCHS suspended publication of the maternal mortality rate in 2007
▪NCHS is publishing an official maternal mortality rate for 2018
▪Definition of Maternal Death – NCHS uses WHO definition of a maternal death: death of a woman while pregnant or within 42 days of termination of pregnancy
▪NCHS uses ICD-10 codes to classify cause of a maternal death
Maternal Mortality Data in the National Vital
Statistics System (NVSS)
▪Before 2003, research showed underreporting of maternal deaths in the NVSS
▪Some states had introduced pregnancy checkbox items to capture pregnancy or recent pregnancy to improve reporting▪Lack of standardization among the various state
death certificates
▪The 2003 revision of the US Standard Death Certificate added the pregnancy checkbox item– recommended for use in all states by the HHS Secretary
Pregnancy
Checkbox
Implementation of the 2003 revision of the US Standard Death Certificate
0
10
20
30
40
50
60
70
80
90
100
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Perc
ent
Cumulative percent of jurisdictions with standard pregnancy checkbox item
Note: As of 2018, all states had implemented the 2003 certificate but California did not use the standard pregnancy item.
Stopped release of national maternal mortality rate
Issues and Consequences of Implementing the Pregnancy Checkbox
▪ The addition of the pregnancy checkbox led to the identification of previously unreported maternal deaths▪ As more states added the checkbox, the total number of identified
deaths in the U.S. increased▪ The increasing use of the checkbox complicated our ability to see
trends in the actual number of maternal deaths
▪ The checkbox was frequently checked in error▪ Research on selected states identified both false positives and
false negatives, though more false positives than false negatives
▪ As the checkbox became more universal, NCHS evaluated how the checkbox was used
Evaluation of the Effect of
Checkbox Implementation
▪One new report from NCHS: 2015 – 2016, NCHS recoded the maternal deaths without the checkbox:
▪Found the effect of checkbox implementation increased reporting, especially for older women
• The cause of death distribution leads us to believe that the majority are not maternal deaths for older women
• For many of these older women, the checkbox was likely checked in error
Evaluation of the Effect of
Checkbox Implementation
▪Another new report from NCHS: Modeling of errors and trends ▪Using log-binomial regression models, NCHS found that the
increase in maternal mortality in the United States is not likely due to a true increase in the underlying extent of maternal mortality
▪ The majority of the observed increase in the MMR is attributed to changes in data collection methods (that is, the gradual adoption of the checkbox over this period)
▪Data visualization will be available soon
Number of Births and Deaths with Positive Pregnancy Responses in the Checkbox
SOURCE: Data from 2013
Current Strategy and Coding Method
▪Coding Change: Further age restriction for checkbox-only cases▪Changed the restriction from 10-54 to 10-44 ▪No age restriction when obstetric conditions are reported on
the death certificate, i.e., maternal deaths due to an explicit obstetric condition will be counted regardless of age
▪Resume annual publication of national maternal mortality rates with the release of the 2018 mortality data and continuing to improve the data and reduce errors
Multiple Options for Analysis
▪Data for 2015-2018 released and made available to researchers▪Coded using the original method▪Recoded data without a checkbox item▪Recoded previously released data using the new coding
method
▪ Increases the availability of trend data to evaluate the addition of the checkbox for multiple years where all or most deaths will be coded under both sets of rules
▪ For checkbox only cases, we retain the original codes in addition to the coding that reflects the checkbox
National Maternal Mortality Rate for 2018
2018 Race Differences for Maternal Mortality
2018 Age Differences for Maternal Mortality
Maternal Mortality Rates without the Pregnancy Checkbox
NOTE: Trend line uses the coding method prior to 2003. Data for 2002 are included for comparison with the 2015–2018 values.
8.9 8.7 8.7
11.5
8.7
17.4
0.0
3.0
6.0
9.0
12.0
15.0
18.0
21.0
2002 2015 2016 2017 2018
Rat
es a
re p
er
10
0,0
00
live
bir
ths
2018 coding method
Planned Improvements in the Collection of Maternal Mortality Data
▪ Enhance understanding of errors in the pregnancy checkbox and how to correct these errors▪ Examine existing EDR systems to see if improvements in design could help improve the data
▪ Develop web service designed to prompt the cause of death certifier to confirm the information provided in the checkbox item
▪ Encourage cooperation between state vital records and state maternal and child health agencies▪ Rapid assessment of deaths of women of reproductive age
▪ Linkages for deaths of women of reproductive age with birth and fetal death records
▪ New information derived from the assessment must then be incorporated in the vital statistics system
Maternal
Mortality
Reports and
Products
https://www.cdc.gov/nchs/maternal-mortality/
Additional Mortality Data Releases
Final 2018 mortality data brief
https://www.cdc.gov/nchs/products/databriefs/db355.htm
Mortality Rate, by race and ethnicity and sex
431.7
633.1
724.2
1,085.2
634.1
874.3
723.6
434.2
631.8
728.0
1,083.3
642.8
885.1
731.9
0 200 400 600 800 1,000 1,200
Hispanic female
Hispanic male
Non-Hispanic black female
Non-Hispanic black male
Non-Hispanic white female
Non-Hispanic white male
Total 2017
2018
Rate per 100,000 U.S. standard population
Source: https://www.cdc.gov/nchs/products/databriefs/db355.htm
Mortality Rates for All Causes and the 10 Leading Causes of Death
Source: https://www.cdc.gov/nchs/products/databriefs/db355.htm
Infant Mortality Rates for the 10 Leading Causes of Infant Death in 2018
Source: https://www.cdc.gov/nchs/products/databriefs/db355.htm
2018 Drug Overdose Data Brief
https://www.cdc.gov/nchs/products/databriefs/db356.htm
0
5
10
15
20
25
30
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Dea
ths
pe
r 1
00
,00
0 s
tan
dar
d p
op
ula
tio
n
Males
Total
Female
2018 rate = 20.7 per 100,000
Age-adjusted drug overdose death rates, by sex
Source: https://www.cdc.gov/nchs/products/databriefs/db356.htm
0
2
4
6
8
10
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Dea
ths
pe
r 1
00
,00
0 s
tan
dar
d p
op
ula
tio
n
Natural and semisynthetic opioids
Drug overdose death rates involving opioids, by type of opioid
Heroin
Methadone
Synthetic opioids other than methadone
Source: https://www.cdc.gov/nchs/products/databriefs/db356.htm
0
2
4
6
8
10
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
De
ath
s p
er
10
0,0
00
sta
nd
ard
po
pu
lati
on
Drug overdose death rates involving psychostimulants, by type of psychostimulant
Cocaine
Psychostimulants with abuse potential
Source: https://www.cdc.gov/nchs/products/databriefs/db356.htm
Monthly Provisional Drug Overdose Death Surveillance
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
12 Month-ending Provisional Number of Drug Overdose Deaths
Source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Period showing decline between 2017 and 2018
Life Expectancy at Selected Ages, by sexAt birth
At age 65
Source: https://www.cdc.gov/nchs/products/databriefs/db355.htm
Life Expectancy Report
https://www.cdc.gov/nchs/data/hestat/life-expectancy/lifeexpectancy-H.pdf
Life Expectancy at Birth, by sex
Year Total Male Female
2010 78.7 76.2 81.02011 78.7 76.3 81.12012 78.8 76.4 81.22013 78.8 76.4 81.22014 78.9 76.5 81.32015 78.7 76.3 81.12016 78.7 76.2 81.12017 78.6 76.1 81.12018 78.7 76.2 81.2
Source: https://www.cdc.gov/nchs/data/hestat/life-expectancy/lifeexpectancy-H.pdf
Total Male Female
Cause of death Percent Cause of death Percent Cause of death Percent
Positive contribution
Cancer 63.4 Cancer 65.3 Cancer 62.7Heart disease 8.5 Viral hepatitis 7.2 Heart disease 8.2Influenza and pneumonia 6.7 Influenza and pneumonia 7.0 Influenza and pneumonia 6.3Viral hepatitis 6.3 HIV disease 4.7 Viral hepatitis 5.3HIV disease 4.0 Heart disease 3.7 Perinatal conditions 5.2Other causes 11.2 Other causes 12.1 Other causes 12.3
Positive total 100.0 Positive total 100.0 Positive total 100.0
Negative contribution
Unintentional injuries 50.6 Unintentional injuries 52.5 Unintentional injuries 40.1Alzheimer disease 10.7 Suicide 8.8 Alzheimer disease 22.7Suicide 7.8 Homicide 8.6 CLRD 4.6
Homicide 7.5 Alzheimer disease 5.9 Stroke 4.3Diabetes 2.8 Diabetes 3.3 Suicide 3.9Other causes 20.6 Other causes 20.9 Other causes 24.4
Negative total 100.0 Negative total 100.0 Negative total 100.0
Percent Contribution to the Changes in Life Expectancy, by cause of death and sex, 2014 – 2017
Source: https://www.cdc.gov/nchs/data/hestat/life-expectancy/lifeexpectancy-H.pdf
Total Male Female
Cause of death Percent Cause of death Percent Cause of death Percent
Positive contribution
Cancer 30.2 Unintentional injuries 32.9 Cancer 27.9
Unintentional injuries 25.4 Cancer 30.8 Unintentional injuries 16.1
CLRD 9.3 Homicide 8.4 Heart disease 13.3
Heart disease 7.0 CLRD 6.0 CLRD 12.7
Homicide 4.7 Viral hepatitis 3.0 Stroke 4.4
Other causes 23.4 Other causes 18.9 Other causes 25.6
Positive total 100.0 Positive total 100.0 Positive total 100.0
Negative contribution
Influenza and pneumonia 27.4 Influenza and pneumonia 24.4 Influenza and pneumonia 28.3
Suicide 12.3 Suicide 11.6 Nutritional deficiencies 15.2
Nutritional deficiencies 10.5 Chronic liver disease 8.3 Suicide 7.7
Chronic liver disease 8.5 Kidney disease 8.2 Parkinson disease 7.4
Parkinson disease 7.2 Diabetes 7.0 Chronic liver disease 6.2
Other causes 34.1 Other causes 40.5 Other causes 35.2
Negative total 100.0 Negative total 100.0 Negative total 100.0
Percent Contribution to Changes in Life Expectancy, by cause of death and sex, 2017 – 2018
Source: https://www.cdc.gov/nchs/data/hestat/life-expectancy/lifeexpectancy-H.pdf
Mortality Reports❖Mortality in the United States, 2018:
https://www.cdc.gov/nchs/data/databriefs/db355-h.pdf❖Drug Overdose Deaths in the United States, 1999 – 2018:
https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf❖Changes in Life Expectancy at Birth, 2010 – 2018:
https://www.cdc.gov/nchs/data/hestat/life-expectancy/lifeexpectancy-H.pdf
❖Evaluation of the Pregnancy Status Checkbox on the Identification of Maternal Deaths: https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69_01-508.pdf
❖The Impact of the Pregnancy Checkbox and Misclassification on Maternal Mortality Trends in the United States, 1999 – 2017: https://www.cdc.gov/nchs/data/series/sr_03/sr03_044-508.pdf
❖Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018: https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69_02-508.pdf
Questions?• Please submit your questions via the chat window in the Skype
application• The facilitator will address questions as time allows. Questions
not answered may be forwarded to [email protected]
www.cdc.gov/nchs
https://www.cdc.gov/nchs/maternal-mortality/
